Abstract
Two patients with lesions in the acetabulum and femur, evident on imaging, were found to have normal marrow elements without a histopathological lesion on curettage of the acetabulum and resection of the femur, respectively. Radiographs on the first patient showed a sclerotic benign appearing acetabular lesion reminiscent of a fibro-osseous lesion while MRI showed the entire lesion to contain fat. The histological features were neither of a fibro-osseous lesion nor a lipoma, but only normal to mildly hypercellular marrow elements. The second patient had a long and expansive femoral osteolytic lesion which on biopsy showed cellular marrow. A subsequent stress fracture led to resection and prosthetic replacement. Microscopic findings revealed only cellular hematopoietic marrow with mature red and white cell lines, megakaryocytes, and a few mast cells devoid of trabecular bones. The microscopic features in the first patient raised the possibility of hematopoietic hyperplasia. Neither the radiographic nor MRI features were consistent with that diagnosis. The spectrum of imaging findings and microscopic appearances in both patients best fit the diagnosis of intraosseous myelolipoma.
Similar content being viewed by others
References
Edelstein G, Kyriakos M. Focal hematopoietic Hyperplasia of the rib: a form of pseudotumor. Skeletal Radiol 1984; 11: 108–118.
Galindo M, Soans S, Chiaramonte C, Garcia FU. Focal hematopoietic hyperplasia of the rib: report of a case diagnosed by fine needle aspiration. Acta Cytol 1998; 42: 987–990.
Lee KB, Kim BS, Cho JH. Focal hematopoietic hyperplasia of the rib. Skelet Radiol 2002; 31: 175–178.
Sawhney R, McRae B, Lazarchick J. A rare case of a multifocal extra-adrenal myelolipoma with markedly hypocellular marrow. Ann Clin Lab Sci 2006; 36: 208–224.
Kenney PJ, Wanger BJ, Rao P, Heffess CS. Myelolipoma: CT and pathologic features. Radiology 1998; 208: 87–95.
Chiarini L, Bertoldi C, Criscuolo M, Ferronato G. Mielolipomatosi: presentazione de un caso a locallizzazione mandibolare. Minerva Stoatol 1992; 41: 165–172.
Prahlow JA, Loggie BW, Cappellari JO, Scharling ES, Teot LA, Isteandar SS. Extra-adrenal myelolipoma: a report of two cases. South Med J 1995; 88: 639–643.
Bordalo-Rodrigues M, Galant C, Lonneux M, Clause D, Vande Berg BC. Focal nodular hyperplasia of the hematopoietic marrow simulating vertebral metastases on FDG position emission tomography. AJR 2003; (3): 1669–1671.
Hartman RP, Sundaram M, Okuno S, Sim FH. Effect of granulocyte colony stimulating factors on marrow of adult patients with musculoskeletal malignancies: incidence and MRI findings. AJR 2004; 183: 645–653.
Author information
Authors and Affiliations
Corresponding author
Additional information
Case 1 was presented at the Members Meeting of the International Skeletal Society held in Vancouver, Canada in 2006.
Rights and permissions
About this article
Cite this article
Sundaram, M., Bauer, T., von Hochstetter, A. et al. Intraosseous myelolipoma. Skeletal Radiol 36, 1181–1184 (2007). https://doi.org/10.1007/s00256-007-0347-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-007-0347-x